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DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

The Division <strong>of</strong> AIDS <strong>Table</strong> <strong>for</strong> <strong>Grading</strong> <strong>the</strong> <strong>Severity</strong> <strong>of</strong> <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> <strong>Adverse</strong> Events (“<strong>DAIDS</strong> AE<br />

<strong>Grading</strong> <strong>Table</strong>”) is a descriptive terminology which can be utilized <strong>for</strong> <strong>Adverse</strong> Event (AE) reporting. A<br />

grading (severity) scale is provided <strong>for</strong> each AE term.<br />

This clarification <strong>of</strong> <strong>the</strong> <strong>DAIDS</strong> <strong>Table</strong> <strong>for</strong> <strong>Grading</strong> <strong>the</strong> <strong>Severity</strong> <strong>of</strong> <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> AE’s provides<br />

additional explanation <strong>of</strong> <strong>the</strong> <strong>DAIDS</strong> AE <strong>Grading</strong> <strong>Table</strong> <strong>and</strong> clarifies some <strong>of</strong> <strong>the</strong> parameters.<br />

I. Instructions <strong>and</strong> Clarifications<br />

<strong>Grading</strong> <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> AEs<br />

The <strong>DAIDS</strong> AE <strong>Grading</strong> <strong>Table</strong> includes parameters <strong>for</strong> grading both <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> AEs. When a<br />

single set <strong>of</strong> parameters is not appropriate <strong>for</strong> grading specific types <strong>of</strong> AEs <strong>for</strong> both <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

populations, separate sets <strong>of</strong> parameters <strong>for</strong> <strong>Adult</strong> <strong>and</strong>/or <strong>Pediatric</strong> populations (with specified respective<br />

age ranges) are given in <strong>the</strong> <strong>Table</strong>. If <strong>the</strong>re is no distinction in <strong>the</strong> <strong>Table</strong> between <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

values <strong>for</strong> a type <strong>of</strong> AE, <strong>the</strong>n <strong>the</strong> single set <strong>of</strong> parameters listed is to be used <strong>for</strong> grading <strong>the</strong> severity <strong>of</strong><br />

both <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> events <strong>of</strong> that type.<br />

Note: In <strong>the</strong> classification <strong>of</strong> adverse events, <strong>the</strong> term “severe” is not <strong>the</strong> same as “serious.”<br />

<strong>Severity</strong> is an indication <strong>of</strong> <strong>the</strong> intensity <strong>of</strong> a specific event (as in mild, moderate, or severe chest<br />

pain). The term “serious” relates to a participant/event outcome or action criteria, usually<br />

associated with events that pose a threat to a participant’s life or functioning.<br />

Addenda 1-3 <strong>Grading</strong> <strong>Table</strong>s <strong>for</strong> Microbicide Studies<br />

For protocols involving topical application <strong>of</strong> products to <strong>the</strong> female genital tract, male genital area or<br />

rectum, strong consideration should be given to using Appendices I-III as <strong>the</strong> primary grading scales <strong>for</strong><br />

<strong>the</strong>se areas. The protocol would need to specifically state that one or more <strong>of</strong> <strong>the</strong> Appendices would be<br />

primary (<strong>and</strong> thus take precedence over <strong>the</strong> main <strong>Grading</strong> <strong>Table</strong>) <strong>for</strong> items that are listed in both <strong>the</strong><br />

Appendix <strong>and</strong> <strong>the</strong> main <strong>Grading</strong> <strong>Table</strong>.<br />

• Addendum 1 - Female Genital <strong>Grading</strong> <strong>Table</strong> <strong>for</strong> Use in Microbicide Studies - PDF<br />

• Addendum 2 - Male Genital <strong>Grading</strong> <strong>Table</strong> <strong>for</strong> Use in Microbicide Studies - PDF<br />

• Addendum 3 - Rectal <strong>Grading</strong> <strong>Table</strong> <strong>for</strong> Use in Microbicide Studies - PDF<br />

Grade 5<br />

For any AE where <strong>the</strong> outcome is death, <strong>the</strong> severity <strong>of</strong> <strong>the</strong> AE is classified as Grade 5.<br />

Estimating <strong>Severity</strong> Grade <strong>for</strong> Parameters Not Identified in <strong>the</strong> <strong>Table</strong><br />

In order to grade a clinical AE that is not identified in <strong>the</strong> <strong>DAIDS</strong> AE grading table, use <strong>the</strong> category<br />

“Estimating <strong>Severity</strong> Grade” located on Page 3.<br />

Determining <strong>Severity</strong> Grade <strong>for</strong> Parameters “Between Grades”<br />

If <strong>the</strong> severity <strong>of</strong> a clinical AE could fall under ei<strong>the</strong>r one <strong>of</strong> two grades (e.g., <strong>the</strong> severity <strong>of</strong> an AE could<br />

be ei<strong>the</strong>r Grade 2 or Grade 3), select <strong>the</strong> higher <strong>of</strong> <strong>the</strong> two grades <strong>for</strong> <strong>the</strong> AE. If a laboratory value that is<br />

graded as a multiple <strong>of</strong> <strong>the</strong> ULN or LLN falls between two grades, select <strong>the</strong> higher <strong>of</strong> <strong>the</strong> two grades <strong>for</strong><br />

<strong>the</strong> AE. For example, Grade 1 is 2.5 x ULN <strong>and</strong> Grade 2 is 2.6 x ULN <strong>for</strong> a parameter. If <strong>the</strong> lab value is<br />

2.53 x ULN (which is between <strong>the</strong> two grades), <strong>the</strong> severity <strong>of</strong> this AE would be Grade 2, <strong>the</strong> higher <strong>of</strong> <strong>the</strong><br />

two grades.<br />

Values Below Grade 1<br />

Any laboratory value that is between ei<strong>the</strong>r <strong>the</strong> LLN or ULN <strong>and</strong> Grade 1 should not be graded.<br />

28-Dec-04/Clarification Aug 09 Page 1 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

Determining <strong>Severity</strong> Grade when Local Laboratory Normal Values Overlap with Grade 1 Ranges<br />

In <strong>the</strong>se situations, <strong>the</strong> severity grading is based on <strong>the</strong> ranges in <strong>the</strong> <strong>DAIDS</strong> AE <strong>Grading</strong> <strong>Table</strong>, even<br />

when <strong>the</strong>re is a reference to <strong>the</strong> local lab LLN.<br />

For example: Phosphate, Serum, Low, <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> > 14 years (Page 20) Grade 1 range is 2.50<br />

mg/dL - < LLN. A particular laboratory’s normal range <strong>for</strong> Phosphate is 2.1 – 3.8 mg/dL. A participant’s<br />

actual lab value is 2.5. In this case, <strong>the</strong> value <strong>of</strong> 2.5 exceeds <strong>the</strong> LLN <strong>for</strong> <strong>the</strong> local lab, but will be graded<br />

as Grade 1 per <strong>DAIDS</strong> AE <strong>Grading</strong> <strong>Table</strong>.<br />

.<br />

II. Definitions <strong>of</strong> terms used in <strong>the</strong> <strong>Table</strong>:<br />

Basic Self-care Functions<br />

<strong>Adult</strong><br />

Activities such as bathing, dressing, toileting, transfer/movement,<br />

continence, <strong>and</strong> feeding.<br />

Young Children<br />

Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with<br />

culturally appropriate eating implement).<br />

LLN<br />

Medical Intervention<br />

NA<br />

Operative Intervention<br />

ULN<br />

Usual Social & Functional<br />

Activities<br />

Lower limit <strong>of</strong> normal<br />

Use <strong>of</strong> pharmacologic or biologic agent(s) <strong>for</strong> treatment <strong>of</strong> an AE.<br />

Not Applicable<br />

Surgical OR o<strong>the</strong>r invasive mechanical procedures.<br />

Upper limit <strong>of</strong> normal<br />

<strong>Adult</strong><br />

Adaptive tasks <strong>and</strong> desirable activities, such as going to work,<br />

shopping, cooking, use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Young Children<br />

Activities that are age <strong>and</strong> culturally appropriate (e.g., social<br />

interactions, play activities, learning tasks, etc.).<br />

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DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

ESTIMATING SEVERITY GRADE<br />

Clinical adverse event<br />

NOT identified<br />

elsewhere in this<br />

<strong>DAIDS</strong> AE <strong>Grading</strong><br />

<strong>Table</strong><br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions OR<br />

Medical or operative<br />

intervention indicated to<br />

prevent permanent<br />

impairment, persistent<br />

disability, or death<br />

SYSTEMIC<br />

Acute systemic<br />

allergic reaction<br />

Localized urticaria<br />

(wheals) with no<br />

medical intervention<br />

indicated<br />

Localized urticaria with<br />

medical intervention<br />

indicated OR Mild<br />

angioedema with no<br />

medical intervention<br />

indicated<br />

Generalized urticaria<br />

OR Angioedema with<br />

medical intervention<br />

indicated OR<br />

Symptomatic mild<br />

bronchospasm<br />

Acute anaphylaxis OR<br />

Life-threatening<br />

bronchospasm OR<br />

laryngeal edema<br />

Chills<br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

NA<br />

Fatigue<br />

Malaise<br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Incapacitating fatigue/<br />

malaise symptoms<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Fever (nonaxillary) 37.7 – 38.6°C 38.7 – 39.3°C 39.4 – 40.5°C > 40.5°C<br />

Pain (indicate body<br />

site)<br />

DO NOT use <strong>for</strong> pain<br />

due to injection (See<br />

Injection Site<br />

Reactions: Injection<br />

site pain)<br />

See also Headache,<br />

Arthralgia, <strong>and</strong><br />

Myalgia<br />

Pain causing no or<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Pain causing greater<br />

than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Pain causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

Disabling pain causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions OR<br />

Hospitalization (o<strong>the</strong>r<br />

than emergency room<br />

visit) indicated<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 3 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Unintentional weight<br />

loss<br />

NA<br />

5 – 9% loss in body<br />

weight from baseline<br />

10 – 19% loss in body<br />

weight from baseline<br />

≥ 20% loss in body<br />

weight from baseline OR<br />

Aggressive intervention<br />

indicated [e.g., tube<br />

feeding or total<br />

parenteral nutrition<br />

(TPN)]<br />

INFECTION<br />

Infection (any o<strong>the</strong>r<br />

than HIV infection)<br />

Localized, no<br />

systemic antimicrobial<br />

treatment indicated<br />

AND Symptoms<br />

causing no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Systemic antimicrobial<br />

treatment indicated<br />

OR Symptoms<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Systemic antimicrobial<br />

treatment indicated<br />

AND Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR Operative<br />

intervention (o<strong>the</strong>r than<br />

simple incision <strong>and</strong><br />

drainage) indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

septic shock)<br />

INJECTION SITE REACTIONS<br />

Injection site pain<br />

(pain without touching)<br />

Or<br />

Tenderness (pain<br />

when area is touched)<br />

Pain/tenderness<br />

causing no or minimal<br />

limitation <strong>of</strong> use <strong>of</strong><br />

limb<br />

Pain/tenderness<br />

limiting use <strong>of</strong> limb OR<br />

Pain/tenderness<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Pain/tenderness<br />

causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

Pain/tenderness causing<br />

inability to per<strong>for</strong>m basic<br />

self-care function OR<br />

Hospitalization (o<strong>the</strong>r<br />

than emergency room<br />

visit) indicated <strong>for</strong><br />

management <strong>of</strong><br />

pain/tenderness<br />

Injection site reaction (localized)<br />

<strong>Adult</strong> > 15 years<br />

Ery<strong>the</strong>ma OR<br />

Induration<br />

<strong>of</strong> 5x5 cm – 9x9 cm<br />

(or 25 cm 2 – 81cm 2 )<br />

Ery<strong>the</strong>ma OR<br />

Induration OR Edema<br />

> 9 cm any diameter<br />

(or > 81 cm 2 )<br />

Ulceration OR<br />

Secondary infection OR<br />

Phlebitis OR Sterile<br />

abscess OR Drainage<br />

Necrosis (involving<br />

dermis <strong>and</strong> deeper<br />

tissue)<br />

<strong>Pediatric</strong> ≤ 15<br />

years<br />

Ery<strong>the</strong>ma OR<br />

Induration OR Edema<br />

present but ≤ 2.5 cm<br />

diameter<br />

Ery<strong>the</strong>ma OR<br />

Induration OR Edema<br />

> 2.5 cm diameter but<br />

< 50% surface area <strong>of</strong><br />

<strong>the</strong> extremity segment<br />

(e.g., upper arm/thigh)<br />

Ery<strong>the</strong>ma OR Induration<br />

OR Edema involving<br />

≥ 50% surface area <strong>of</strong><br />

<strong>the</strong> extremity segment<br />

(e.g., upper arm/thigh)<br />

OR Ulceration OR<br />

Secondary infection OR<br />

Phlebitis OR Sterile<br />

abscess OR Drainage<br />

Necrosis (involving<br />

dermis <strong>and</strong> deeper<br />

tissue)<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 4 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Pruritis associated<br />

with injection<br />

See also Skin: Pruritis<br />

(itching - no skin<br />

lesions)<br />

Itching localized to<br />

injection site AND<br />

Relieved<br />

spontaneously or with<br />

< 48 hours treatment<br />

Itching beyond <strong>the</strong><br />

injection site but not<br />

generalized OR Itching<br />

localized to injection<br />

site requiring ≥ 48<br />

hours treatment<br />

Generalized itching<br />

causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

NA<br />

SKIN – DERMATOLOGICAL<br />

Alopecia<br />

Thinning detectable<br />

by study participant<br />

(or by caregiver <strong>for</strong><br />

young children <strong>and</strong><br />

disabled adults)<br />

Thinning or patchy hair<br />

loss detectable by<br />

health care provider<br />

Complete hair loss<br />

NA<br />

Cutaneous reaction –<br />

rash<br />

Localized macular<br />

rash<br />

Diffuse macular,<br />

maculopapular, or<br />

morbilli<strong>for</strong>m rash OR<br />

Target lesions<br />

Diffuse macular,<br />

maculopapular, or<br />

morbilli<strong>for</strong>m rash with<br />

vesicles or limited<br />

number <strong>of</strong> bullae OR<br />

Superficial ulcerations<br />

<strong>of</strong> mucous membrane<br />

limited to one site<br />

Extensive or generalized<br />

bullous lesions OR<br />

Stevens-Johnson<br />

syndrome OR Ulceration<br />

<strong>of</strong> mucous membrane<br />

involving two or more<br />

distinct mucosal sites<br />

OR Toxic epidermal<br />

necrolysis (TEN)<br />

Hyperpigmentation Slight or localized Marked or generalized NA NA<br />

Hypopigmentation Slight or localized Marked or generalized NA NA<br />

Pruritis (itching – no<br />

skin lesions)<br />

(See also Injection<br />

Site Reactions:<br />

Pruritis associated<br />

with injection)<br />

Itching causing no or<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Itching causing greater<br />

than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Itching causing inability<br />

to per<strong>for</strong>m usual social<br />

& functional activities<br />

NA<br />

CARDIOVASCULAR<br />

Cardiac arrhythmia<br />

(general)<br />

(By ECG or physical<br />

exam)<br />

Asymptomatic AND<br />

No intervention<br />

indicated<br />

Asymptomatic AND<br />

Non-urgent medical<br />

intervention indicated<br />

Symptomatic, non-lifethreatening<br />

AND Nonurgent<br />

medical<br />

intervention indicated<br />

Life-threatening<br />

arrhythmia OR Urgent<br />

intervention indicated<br />

Cardiacischemia/infarction<br />

NA NA Symptomatic ischemia<br />

(stable angina) OR<br />

Testing consistent with<br />

ischemia<br />

Unstable angina OR<br />

Acute myocardial<br />

infarction<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 5 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Hemorrhage<br />

(significant acute<br />

blood loss)<br />

NA<br />

Symptomatic AND No<br />

transfusion indicated<br />

Symptomatic AND<br />

Transfusion <strong>of</strong> ≤ 2 units<br />

packed RBCs (<strong>for</strong><br />

children ≤ 10 cc/kg)<br />

indicated<br />

Life-threatening<br />

hypotension OR<br />

Transfusion <strong>of</strong> > 2 units<br />

packed RBCs (<strong>for</strong><br />

children > 10 cc/kg)<br />

indicated<br />

Hypertension<br />

<strong>Adult</strong> > 17 years<br />

(with repeat testing<br />

at same visit)<br />

140 – 159 mmHg<br />

systolic<br />

OR<br />

90 – 99 mmHg<br />

diastolic<br />

160 – 179 mmHg<br />

systolic<br />

OR<br />

100 – 109 mmHg<br />

diastolic<br />

≥ 180 mmHg systolic<br />

OR<br />

≥ 110 mmHg diastolic<br />

Life-threatening<br />

consequences (e.g.,<br />

malignant hypertension)<br />

OR Hospitalization<br />

indicated (o<strong>the</strong>r than<br />

emergency room visit)<br />

Correction: in Grade 2 to 160 - 179 from > 160-179 (systolic) <strong>and</strong> to ≥ 100 -109 from > 100-109 (diastolic) <strong>and</strong><br />

in Grade 3 to ≥ 180 from > 180 (systolic) <strong>and</strong> to ≥ 110 from > 110 (diastolic).<br />

<strong>Pediatric</strong> ≤ 17<br />

years<br />

(with repeat<br />

testing at same<br />

visit)<br />

NA<br />

91 st – 94 th percentile<br />

adjusted <strong>for</strong> age,<br />

height, <strong>and</strong> gender<br />

(systolic <strong>and</strong>/or<br />

diastolic)<br />

≥ 95 th percentile<br />

adjusted <strong>for</strong> age, height,<br />

<strong>and</strong> gender (systolic<br />

<strong>and</strong>/or diastolic)<br />

Life-threatening<br />

consequences (e.g.,<br />

malignant hypertension)<br />

OR Hospitalization<br />

indicated (o<strong>the</strong>r than<br />

emergency room visit)<br />

Hypotension NA Symptomatic,<br />

corrected with oral<br />

fluid replacement<br />

Symptomatic, IV fluids<br />

indicated<br />

Shock requiring use <strong>of</strong><br />

vasopressors or<br />

mechanical assistance<br />

to maintain blood<br />

pressure<br />

Pericardial effusion<br />

Asymptomatic, small<br />

effusion requiring no<br />

intervention<br />

Asymptomatic,<br />

moderate or larger<br />

effusion requiring no<br />

intervention<br />

Effusion with non-life<br />

threatening physiologic<br />

consequences OR<br />

Effusion with non-urgent<br />

intervention indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

tamponade) OR Urgent<br />

intervention indicated<br />

Prolonged PR interval<br />

<strong>Adult</strong> > 16 years<br />

PR interval<br />

0.21 – 0.25 sec<br />

PR interval<br />

> 0.25 sec<br />

Type II 2 nd degree AV<br />

block OR Ventricular<br />

pause > 3.0 sec<br />

Complete AV block<br />

<strong>Pediatric</strong> ≤ 16<br />

years<br />

1 st degree AV block<br />

(PR > normal <strong>for</strong> age<br />

<strong>and</strong> rate)<br />

Type I 2 nd degree AV<br />

block<br />

Type II 2 nd degree AV<br />

block<br />

Complete AV block<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 6 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Prolonged QTc<br />

<strong>Adult</strong> > 16 years<br />

Asymptomatic, QTc<br />

interval 0.45 – 0.47<br />

sec OR Increase<br />

interval < 0.03 sec<br />

above baseline<br />

Asymptomatic, QTc<br />

interval 0.48 – 0.49<br />

sec OR Increase in<br />

interval 0.03 – 0.05<br />

sec above baseline<br />

Asymptomatic, QTc<br />

interval ≥ 0.50 sec OR<br />

Increase in interval<br />

≥ 0.06 sec above<br />

baseline<br />

Life-threatening<br />

consequences, e.g.<br />

Torsade de pointes or<br />

o<strong>the</strong>r associated serious<br />

ventricular dysrhythmia<br />

<strong>Pediatric</strong> ≤ 16<br />

years<br />

Asymptomatic, QTc<br />

interval 0.450 –<br />

0.464 sec<br />

Asymptomatic, QTc<br />

interval 0.465 –<br />

0.479 sec<br />

Asymptomatic, QTc<br />

interval ≥ 0.480 sec<br />

Life-threatening<br />

consequences, e.g.<br />

Torsade de pointes or<br />

o<strong>the</strong>r associated serious<br />

ventricular dysrhythmia<br />

Thrombosis/embolism NA Deep vein thrombosis<br />

AND No intervention<br />

indicated (e.g.,<br />

anticoagulation, lysis<br />

filter, invasive<br />

procedure)<br />

Deep vein thrombosis<br />

AND Intervention<br />

indicated (e.g.,<br />

anticoagulation, lysis<br />

filter, invasive<br />

procedure)<br />

Embolic event (e.g.,<br />

pulmonary embolism,<br />

life-threatening<br />

thrombus)<br />

Vasovagal episode<br />

(associated with a<br />

procedure <strong>of</strong> any kind)<br />

Present without loss<br />

<strong>of</strong> consciousness<br />

Present with transient<br />

loss <strong>of</strong> consciousness<br />

NA<br />

NA<br />

Ventricular<br />

dysfunction<br />

(congestive heart<br />

failure)<br />

NA<br />

Asymptomatic<br />

diagnostic finding AND<br />

intervention indicated<br />

New onset with<br />

symptoms OR<br />

Worsening symptomatic<br />

congestive heart failure<br />

Life-threatening<br />

congestive heart failure<br />

GASTROINTESTINAL<br />

Anorexia<br />

Loss <strong>of</strong> appetite<br />

without decreased<br />

oral intake<br />

Loss <strong>of</strong> appetite<br />

associated with<br />

decreased oral intake<br />

without significant<br />

weight loss<br />

Loss <strong>of</strong> appetite<br />

associated with<br />

significant weight loss<br />

Life-threatening<br />

consequences OR<br />

Aggressive intervention<br />

indicated [e.g., tube<br />

feeding or total<br />

parenteral nutrition<br />

(TPN)]<br />

Comment: Please note that, while <strong>the</strong> grading scale provided <strong>for</strong> Unintentional Weight Loss may be used as a guideline when<br />

grading anorexia, this is not a requirement <strong>and</strong> should not be used as a substitute <strong>for</strong> clinical judgment.<br />

Ascites Asymptomatic Symptomatic AND<br />

Intervention indicated<br />

(e.g., diuretics or<br />

<strong>the</strong>rapeutic<br />

paracentesis)<br />

Symptomatic despite<br />

intervention<br />

Life-threatening<br />

consequences<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 7 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Cholecystitis NA Symptomatic AND<br />

Medical intervention<br />

indicated<br />

Radiologic, endoscopic,<br />

or operative intervention<br />

indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

sepsis or per<strong>for</strong>ation)<br />

Constipation NA Persistent constipation<br />

requiring regular use<br />

<strong>of</strong> dietary<br />

modifications,<br />

laxatives, or enemas<br />

Diarrhea<br />

Obstipation with manual<br />

evacuation indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

obstruction)<br />

<strong>Adult</strong> <strong>and</strong><br />

<strong>Pediatric</strong> ≥ 1 year<br />

Transient or<br />

intermittent episodes<br />

<strong>of</strong> un<strong>for</strong>med stools<br />

OR Increase <strong>of</strong> ≤ 3<br />

stools over baseline<br />

per 24-hour period<br />

Persistent episodes <strong>of</strong><br />

un<strong>for</strong>med to watery<br />

stools OR Increase <strong>of</strong><br />

4 – 6 stools over<br />

baseline per 24-hour<br />

period<br />

Bloody diarrhea OR<br />

Increase <strong>of</strong> ≥ 7 stools<br />

per 24-hour period OR<br />

IV fluid replacement<br />

indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

hypotensive shock)<br />

<strong>Pediatric</strong> < 1 year<br />

Liquid stools (more<br />

un<strong>for</strong>med than usual)<br />

but usual number <strong>of</strong><br />

stools<br />

Liquid stools with<br />

increased number <strong>of</strong><br />

stools OR Mild<br />

dehydration<br />

Liquid stools with<br />

moderate dehydration<br />

Liquid stools resulting in<br />

severe dehydration with<br />

aggressive rehydration<br />

indicated OR<br />

Hypotensive shock<br />

Dysphagia-<br />

Odynophagia<br />

Symptomatic but able<br />

to eat usual diet<br />

Symptoms causing<br />

altered dietary intake<br />

without medical<br />

intervention indicated<br />

Symptoms causing<br />

severely altered dietary<br />

intake with medical<br />

intervention indicated<br />

Life-threatening<br />

reduction in oral intake<br />

Mucositis/stomatitis<br />

(clinical exam)<br />

Indicate site (e.g.,<br />

larynx, oral)<br />

See Genitourinary <strong>for</strong><br />

Vulvovaginitis<br />

Ery<strong>the</strong>ma <strong>of</strong> <strong>the</strong><br />

mucosa<br />

Patchy<br />

pseudomembranes or<br />

ulcerations<br />

Confluent<br />

pseudomembranes or<br />

ulcerations OR Mucosal<br />

bleeding with minor<br />

trauma<br />

Tissue necrosis OR<br />

Diffuse spontaneous<br />

mucosal bleeding OR<br />

Life-threatening<br />

consequences (e.g.,<br />

aspiration, choking)<br />

See also Dysphagia-<br />

Odynophagia <strong>and</strong><br />

Proctitis<br />

Nausea<br />

Transient (< 24 hours)<br />

or intermittent nausea<br />

with no or minimal<br />

interference with oral<br />

intake<br />

Persistent nausea<br />

resulting in decreased<br />

oral intake <strong>for</strong> 24 – 48<br />

hours<br />

Persistent nausea<br />

resulting in minimal oral<br />

intake <strong>for</strong> > 48 hours<br />

OR Aggressive<br />

rehydration indicated<br />

(e.g., IV fluids)<br />

Life-threatening<br />

consequences (e.g.,<br />

hypotensive shock)<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 8 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Pancreatitis NA Symptomatic AND<br />

Hospitalization not<br />

indicated (o<strong>the</strong>r than<br />

emergency room visit)<br />

Symptomatic AND<br />

Hospitalization indicated<br />

(o<strong>the</strong>r than emergency<br />

room visit)<br />

Life-threatening<br />

consequences (e.g.,<br />

circulatory failure,<br />

hemorrhage, sepsis)<br />

Proctitis (functionalsymptomatic)<br />

Also see<br />

Mucositis/stomatitis<br />

<strong>for</strong> clinical exam<br />

Rectal discom<strong>for</strong>t<br />

AND No intervention<br />

indicated<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities OR Medical<br />

intervention indicated<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR Operative<br />

intervention indicated<br />

Life-threatening<br />

consequences (e.g.,<br />

per<strong>for</strong>ation)<br />

Vomiting<br />

Transient or<br />

intermittent vomiting<br />

with no or minimal<br />

interference with oral<br />

intake<br />

Frequent episodes <strong>of</strong><br />

vomiting with no or<br />

mild dehydration<br />

Persistent vomiting<br />

resulting in orthostatic<br />

hypotension OR<br />

Aggressive rehydration<br />

indicated (e.g., IV fluids)<br />

Life-threatening<br />

consequences (e.g.,<br />

hypotensive shock)<br />

NEUROLOGIC<br />

Alteration in<br />

personality-behavior<br />

or in mood (e.g.,<br />

agitation, anxiety,<br />

depression, mania,<br />

psychosis)<br />

Alteration causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Alteration causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Alteration causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Behavior potentially<br />

harmful to self or o<strong>the</strong>rs<br />

(e.g., suicidal <strong>and</strong><br />

homicidal ideation or<br />

attempt, acute<br />

psychosis) OR Causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions<br />

Altered Mental Status<br />

For Dementia, see<br />

Cognitive <strong>and</strong><br />

behavioral/attentional<br />

disturbance (including<br />

dementia <strong>and</strong><br />

attention deficit<br />

disorder)<br />

Changes causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Mild lethargy or<br />

somnolence causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Confusion, memory<br />

impairment, lethargy, or<br />

somnolence causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Delirium OR<br />

obtundation, OR coma<br />

Ataxia<br />

Asymptomatic ataxia<br />

detectable on exam<br />

OR Minimal ataxia<br />

causing no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptomatic ataxia<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Symptomatic ataxia<br />

causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

Disabling ataxia causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 9 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Cognitive <strong>and</strong><br />

behavioral/attentional<br />

disturbance (including<br />

dementia <strong>and</strong><br />

attention deficit<br />

disorder)<br />

Disability causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

OR Specialized<br />

resources not<br />

indicated<br />

Disability causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities OR<br />

Specialized resources<br />

on part-time basis<br />

indicated<br />

Disability causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR<br />

Specialized resources<br />

on a full-time basis<br />

indicated<br />

Disability causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions OR<br />

Institutionalization<br />

indicated<br />

CNS ischemia<br />

(acute)<br />

NA NA Transient ischemic<br />

attack<br />

Cerebral vascular<br />

accident (CVA, stroke)<br />

with neurological deficit<br />

Developmental delay<br />

– <strong>Pediatric</strong> ≤ 16<br />

years<br />

Mild developmental<br />

delay, ei<strong>the</strong>r motor or<br />

cognitive, as<br />

determined by<br />

comparison with a<br />

developmental<br />

screening tool<br />

appropriate <strong>for</strong> <strong>the</strong><br />

setting<br />

Moderate<br />

developmental delay,<br />

ei<strong>the</strong>r motor or<br />

cognitive, as<br />

determined by<br />

comparison with a<br />

developmental<br />

screening tool<br />

appropriate <strong>for</strong> <strong>the</strong><br />

setting<br />

Severe developmental<br />

delay, ei<strong>the</strong>r motor or<br />

cognitive, as determined<br />

by comparison with a<br />

developmental<br />

screening tool<br />

appropriate <strong>for</strong> <strong>the</strong><br />

setting<br />

Developmental<br />

regression, ei<strong>the</strong>r motor<br />

or cognitive, as<br />

determined by<br />

comparison with a<br />

developmental<br />

screening tool<br />

appropriate <strong>for</strong> <strong>the</strong><br />

setting<br />

Headache<br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions OR<br />

Hospitalization indicated<br />

(o<strong>the</strong>r than emergency<br />

room visit) OR<br />

Headache with<br />

significant impairment <strong>of</strong><br />

alertness or o<strong>the</strong>r<br />

neurologic function<br />

Insomnia NA Difficulty sleeping<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Difficulty sleeping<br />

causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

Disabling insomnia<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Neuromuscular<br />

weakness<br />

(including myopathy &<br />

neuropathy)<br />

Asymptomatic with<br />

decreased strength<br />

on exam OR Minimal<br />

muscle weakness<br />

causing no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Muscle weakness<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Muscle weakness<br />

causing inability to<br />

per<strong>for</strong>m usual social &<br />

functional activities<br />

Disabling muscle<br />

weakness causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions OR<br />

Respiratory muscle<br />

weakness impairing<br />

ventilation<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 10 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Neurosensory<br />

alteration (including<br />

pares<strong>the</strong>sia <strong>and</strong><br />

painful neuropathy)<br />

Asymptomatic with<br />

sensory alteration on<br />

exam or minimal<br />

pares<strong>the</strong>sia causing<br />

no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Sensory alteration or<br />

pares<strong>the</strong>sia causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Sensory alteration or<br />

pares<strong>the</strong>sia causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Disabling sensory<br />

alteration or pares<strong>the</strong>sia<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Seizure: (new onset)<br />

– <strong>Adult</strong> ≥ 18 years<br />

See also Seizure:<br />

(known pre-existing<br />

seizure disorder)<br />

NA 1 seizure 2 – 4 seizures Seizures <strong>of</strong> any kind<br />

which are prolonged,<br />

repetitive (e.g., status<br />

epilepticus), or difficult<br />

to control (e.g.,<br />

refractory epilepsy)<br />

Seizure: (known preexisting<br />

seizure<br />

disorder)<br />

– <strong>Adult</strong> ≥ 18 years<br />

For worsening <strong>of</strong><br />

existing epilepsy <strong>the</strong><br />

grades should be<br />

based on an increase<br />

from previous level <strong>of</strong><br />

control to any <strong>of</strong> <strong>the</strong>se<br />

levels.<br />

NA<br />

Increased frequency <strong>of</strong><br />

pre-existing seizures<br />

(non-repetitive) without<br />

change in seizure<br />

character OR<br />

Infrequent breakthrough<br />

seizures while<br />

on stable medication<br />

in a previously<br />

controlled seizure<br />

disorder<br />

Change in seizure<br />

character from baseline<br />

ei<strong>the</strong>r in duration or<br />

quality (e.g., severity or<br />

focality)<br />

Seizures <strong>of</strong> any kind<br />

which are prolonged,<br />

repetitive (e.g., status<br />

epilepticus), or difficult<br />

to control (e.g.,<br />

refractory epilepsy)<br />

Seizure<br />

– <strong>Pediatric</strong> < 18<br />

years<br />

Seizure, generalized<br />

onset with or without<br />

secondary<br />

generalization, lasting<br />

< 5 minutes with < 24<br />

hours post ictal state<br />

Seizure, generalized<br />

onset with or without<br />

secondary<br />

generalization, lasting<br />

5 – 20 minutes with<br />

< 24 hours post ictal<br />

state<br />

Seizure, generalized<br />

onset with or without<br />

secondary<br />

generalization, lasting<br />

> 20 minutes<br />

Seizure, generalized<br />

onset with or without<br />

secondary<br />

generalization, requiring<br />

intubation <strong>and</strong> sedation<br />

Syncope (not<br />

associated with a<br />

procedure)<br />

NA Present NA NA<br />

Vertigo<br />

Vertigo causing no or<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Vertigo causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Vertigo causing inability<br />

to per<strong>for</strong>m usual social<br />

& functional activities<br />

Disabling vertigo<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 11 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

RESPIRATORY<br />

Bronchospasm (acute)<br />

FEV1 or peak flow<br />

reduced to<br />

70 – 80%<br />

FEV1 or peak flow<br />

50 – 69%<br />

FEV1 or peak flow<br />

25 – 49%<br />

Cyanosis OR FEV1 or<br />

peak flow < 25% OR<br />

Intubation<br />

Dyspnea or respiratory distress<br />

<strong>Adult</strong> ≥ 14 years<br />

Dyspnea on exertion<br />

with no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Dyspnea on exertion<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Dyspnea at rest causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Respiratory failure with<br />

ventilatory support<br />

indicated<br />

<strong>Pediatric</strong> < 14<br />

years<br />

Wheezing OR<br />

minimal increase in<br />

respiratory rate <strong>for</strong><br />

age<br />

Nasal flaring OR<br />

Intercostal retractions<br />

OR Pulse oximetry 90<br />

– 95%<br />

Dyspnea at rest causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR Pulse<br />

oximetry < 90%<br />

Respiratory failure with<br />

ventilatory support<br />

indicated<br />

MUSCULOSKELETAL<br />

Arthralgia<br />

See also Arthritis<br />

Joint pain causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Joint pain causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Joint pain causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Disabling joint pain<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Arthritis<br />

See also Arthralgia<br />

Stiffness or joint<br />

swelling causing no or<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Stiffness or joint<br />

swelling causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Stiffness or joint<br />

swelling causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Disabling joint stiffness<br />

or swelling causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions<br />

Bone Mineral Loss<br />

<strong>Adult</strong> ≥ 21 years<br />

BMD t-score<br />

-2.5 to -1.0<br />

BMD t-score < -2.5<br />

Pathological fracture<br />

(including loss <strong>of</strong><br />

vertebral height)<br />

Pathologic fracture<br />

causing life-threatening<br />

consequences<br />

<strong>Pediatric</strong> < 21<br />

years<br />

BMD z-score<br />

-2.5 to -1.0<br />

BMD z-score < -2.5<br />

Pathological fracture<br />

(including loss <strong>of</strong><br />

vertebral height)<br />

Pathologic fracture<br />

causing life-threatening<br />

consequences<br />

Myalgia<br />

(non-injection site)<br />

Muscle pain causing<br />

no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Muscle pain causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Muscle pain causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Disabling muscle pain<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 12 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Osteonecrosis NA Asymptomatic with<br />

radiographic findings<br />

AND No operative<br />

intervention indicated<br />

GENITOURINARY<br />

Symptomatic bone pain<br />

with radiographic<br />

findings OR Operative<br />

intervention indicated<br />

Disabling bone pain with<br />

radiographic findings<br />

causing inability to<br />

per<strong>for</strong>m basic self-care<br />

functions<br />

Cervicitis<br />

(symptoms)<br />

(For use in studies<br />

evaluating topical<br />

study agents)<br />

For o<strong>the</strong>r cervicitis see<br />

Infection: Infection<br />

(any o<strong>the</strong>r than HIV<br />

infection)<br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions<br />

Cervicitis<br />

(clinical exam)<br />

(For use in studies<br />

evaluating topical<br />

study agents)<br />

For o<strong>the</strong>r cervicitis see<br />

Infection: Infection<br />

(any o<strong>the</strong>r than HIV<br />

infection)<br />

Minimal cervical<br />

abnormalities on<br />

examination<br />

(ery<strong>the</strong>ma,<br />

mucopurulent<br />

discharge, or friability)<br />

OR Epi<strong>the</strong>lial<br />

disruption<br />

< 25% <strong>of</strong> total surface<br />

Moderate cervical<br />

abnormalities on<br />

examination<br />

(ery<strong>the</strong>ma,<br />

mucopurulent<br />

discharge, or friability)<br />

OR Epi<strong>the</strong>lial<br />

disruption <strong>of</strong> 25 – 49%<br />

total surface<br />

Severe cervical<br />

abnormalities on<br />

examination (ery<strong>the</strong>ma,<br />

mucopurulent<br />

discharge, or friability)<br />

OR Epi<strong>the</strong>lial disruption<br />

50 – 75% total surface<br />

Epi<strong>the</strong>lial disruption<br />

> 75% total surface<br />

Inter-menstrual<br />

bleeding (IMB)<br />

Spotting observed by<br />

participant OR<br />

Minimal blood<br />

observed during<br />

clinical or colposcopic<br />

examination<br />

Inter-menstrual<br />

bleeding not greater in<br />

duration or amount<br />

than usual menstrual<br />

cycle<br />

Inter-menstrual bleeding<br />

greater in duration or<br />

amount than usual<br />

menstrual cycle<br />

Hemorrhage with lifethreatening<br />

hypotension<br />

OR Operative<br />

intervention indicated<br />

Urinary tract<br />

obstruction (e.g.,<br />

stone)<br />

NA<br />

Signs or symptoms <strong>of</strong><br />

urinary tract<br />

obstruction without<br />

hydronephrosis or<br />

renal dysfunction<br />

Signs or symptoms <strong>of</strong><br />

urinary tract obstruction<br />

with hydronephrosis or<br />

renal dysfunction<br />

Obstruction causing lifethreatening<br />

consequences<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 13 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Vulvovaginitis<br />

(symptoms)<br />

(Use in studies<br />

evaluating topical<br />

study agents)<br />

Symptoms causing no<br />

or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Symptoms causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Symptoms causing<br />

inability to per<strong>for</strong>m basic<br />

self-care functions<br />

For o<strong>the</strong>r<br />

vulvovaginitis see<br />

Infection: Infection<br />

(any o<strong>the</strong>r than HIV<br />

infection)<br />

Vulvovaginitis<br />

(clinical exam)<br />

(Use in studies<br />

evaluating topical<br />

study agents)<br />

Minimal vaginal<br />

abnormalities on<br />

examination OR<br />

Epi<strong>the</strong>lial disruption<br />

< 25% <strong>of</strong> total surface<br />

Moderate vaginal<br />

abnormalities on<br />

examination OR<br />

Epi<strong>the</strong>lial disruption <strong>of</strong><br />

25 - 49% total surface<br />

Severe vaginal<br />

abnormalities on<br />

examination OR<br />

Epi<strong>the</strong>lial disruption<br />

50 - 75% total surface<br />

Vaginal per<strong>for</strong>ation OR<br />

Epi<strong>the</strong>lial disruption<br />

> 75% total surface<br />

For o<strong>the</strong>r<br />

vulvovaginitis see<br />

Infection: Infection<br />

(any o<strong>the</strong>r than HIV<br />

infection)<br />

OCULAR/VISUAL<br />

Uveitis<br />

Asymptomatic but<br />

detectable on exam<br />

Symptomatic anterior<br />

uveitis OR Medical<br />

intervention indicated<br />

Posterior or pan-uveitis<br />

OR Operative<br />

intervention indicated<br />

Disabling visual loss in<br />

affected eye(s)<br />

Visual changes (from<br />

baseline)<br />

Visual changes<br />

causing no or minimal<br />

interference with<br />

usual social &<br />

functional activities<br />

Visual changes<br />

causing greater than<br />

minimal interference<br />

with usual social &<br />

functional activities<br />

Visual changes causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities<br />

Disabling visual loss in<br />

affected eye(s)<br />

ENDOCRINE/METABOLIC<br />

Abnormal fat<br />

accumulation<br />

(e.g., back <strong>of</strong> neck,<br />

breasts, abdomen)<br />

Detectable by study<br />

participant (or by<br />

caregiver <strong>for</strong> young<br />

children <strong>and</strong> disabled<br />

adults)<br />

Detectable on physical<br />

exam by health care<br />

provider<br />

Disfiguring OR Obvious<br />

changes on casual<br />

visual inspection<br />

NA<br />

Diabetes mellitus NA New onset without<br />

need to initiate<br />

medication OR<br />

Modification <strong>of</strong> current<br />

medications to regain<br />

glucose control<br />

New onset with initiation<br />

<strong>of</strong> medication indicated<br />

OR Diabetes<br />

uncontrolled despite<br />

treatment modification<br />

Life-threatening<br />

consequences (e.g.,<br />

ketoacidosis,<br />

hyperosmolar nonketotic<br />

coma)<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 14 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Gynecomastia<br />

Detectable by study<br />

participant or<br />

caregiver (<strong>for</strong> young<br />

children <strong>and</strong> disabled<br />

adults)<br />

Detectable on physical<br />

exam by health care<br />

provider<br />

Disfiguring OR Obvious<br />

on casual visual<br />

inspection<br />

NA<br />

Hyperthyroidism Asymptomatic Symptomatic causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities OR Thyroid<br />

suppression <strong>the</strong>rapy<br />

indicated<br />

Hypothyroidism Asymptomatic Symptomatic causing<br />

greater than minimal<br />

interference with usual<br />

social & functional<br />

activities OR Thyroid<br />

replacement <strong>the</strong>rapy<br />

indicated<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR<br />

Uncontrolled despite<br />

treatment modification<br />

Symptoms causing<br />

inability to per<strong>for</strong>m usual<br />

social & functional<br />

activities OR<br />

Uncontrolled despite<br />

treatment modification<br />

Life-threatening<br />

consequences (e.g.,<br />

thyroid storm)<br />

Life-threatening<br />

consequences (e.g.,<br />

myxedema coma)<br />

Lipoatrophy<br />

(e.g., fat loss from <strong>the</strong><br />

face, extremities,<br />

buttocks)<br />

Detectable by study<br />

participant (or by<br />

caregiver <strong>for</strong> young<br />

children <strong>and</strong> disabled<br />

adults)<br />

Detectable on physical<br />

exam by health care<br />

provider<br />

Disfiguring OR Obvious<br />

on casual visual<br />

inspection<br />

NA<br />

Basic Self-care Functions – <strong>Adult</strong>: Activities such as bathing, dressing, toileting, transfer/movement, continence, <strong>and</strong> feeding.<br />

Basic Self-care Functions – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., feeding self with culturally<br />

appropriate eating implement).<br />

Usual Social & Functional Activities – <strong>Adult</strong>: Adaptive tasks <strong>and</strong> desirable activities, such as going to work, shopping, cooking,<br />

use <strong>of</strong> transportation, pursuing a hobby, etc.<br />

Usual Social & Functional Activities – Young Children: Activities that are age <strong>and</strong> culturally appropriate (e.g., social interactions,<br />

play activities, learning tasks, etc.).<br />

28 Dec 04/Clarification Aug 09 Page 15 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

HEMATOLOGY<br />

St<strong>and</strong>ard International Units are listed in italics<br />

Absolute CD4+ count<br />

– <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

> 13 years<br />

(HIV NEGATIVE ONLY)<br />

Absolute lymphocyte<br />

count<br />

– <strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

> 13 years<br />

(HIV NEGATIVE ONLY)<br />

300 – 400/mm 3<br />

300 – 400/µL<br />

600 – 650/mm 3<br />

0.600 x 10 9 –<br />

0.650 x 10 9 /L<br />

200 – 299/mm 3<br />

200 – 299/µL<br />

500 – 599/mm 3<br />

0.500 x 10 9 –<br />

0.599 x 10 9 /L<br />

100 – 199/mm 3<br />

100 – 199/µL<br />

350 – 499/mm 3<br />

0.350 x 10 9 –<br />

0.499 x 10 9 /L<br />

< 100/mm 3<br />

< 100/µL<br />

< 350/mm 3<br />

< 0.350 x 10 9 /L<br />

Comment: Values in children ≤ 13 years are not given <strong>for</strong> <strong>the</strong> two parameters above because <strong>the</strong> absolute counts are variable.<br />

Absolute neutrophil count (ANC)<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong>,<br />

> 7 days<br />

1,000 – 1,300/mm 3<br />

1.000 x 10 9 –<br />

1.300 x 10 9 /L<br />

Infant ∗† , 2 – ≤ 7 days 1,250 – 1,500/mm 3<br />

1.250 x 10 9 –<br />

1.500 x 10 9 /L<br />

Infant ∗† , ≤1 day 4,000 – 5,000/mm 3<br />

4.000 x 10 9 –<br />

5.000 x 10 9 /L<br />

750 – 999/mm 3<br />

0.750 x 10 9 –<br />

0.999 x 10 9 /L<br />

1,000 – 1,249/mm 3<br />

1.000 x 10 9 –<br />

1.249 x 10 9 /L<br />

3,000 – 3,999/mm 3<br />

3.000 x 10 9 –<br />

3.999 x10 9 /L<br />

Comment: Parameter changed from “Infant, < 1 day” to “Infant, ≤1 day”<br />

Fibrinogen, decreased<br />

100 – 200 mg/dL<br />

1.00 – 2.00 g/L<br />

OR<br />

0.75 – 0.99 x LLN<br />

75 – 99 mg/dL<br />

0.75 – 0.99 g/L<br />

OR<br />

0.50 – 0.74 x LLN<br />

500 – 749/mm 3<br />

0.500 x 10 9 –<br />

0.749 x 10 9 /L<br />

750 – 999/mm 3<br />

0.750 x 10 9 –<br />

0.999 x 10 9 /L<br />

1,500 – 2,999/mm 3<br />

1.500 x 10 9 –<br />

2.999 x 10 9 /L<br />

50 – 74 mg/dL<br />

0.50 – 0.74 g/L<br />

OR<br />

0.25 – 0.49 x LLN<br />

< 500/mm 3<br />

< 0.500 x 10 9 /L<br />

< 750/mm 3<br />

< 0.750 x 10 9 /L<br />

< 1,500/mm 3<br />

< 1.500 x 10 9 /L<br />

< 50 mg/dL<br />

< 0.50 g/L<br />

OR<br />

< 0.25 x LLN<br />

OR<br />

Associated with gross<br />

bleeding<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 16 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Hemoglobin (Hgb)<br />

Comment: The Hgb values in mmol/L have changed because <strong>the</strong> conversion factor used to convert g/dL to mmol/L has been<br />

changed from 0.155 to 0.6206 (<strong>the</strong> most commonly used conversion factor). For grading Hgb results obtained by an analytic<br />

method with a conversion factor o<strong>the</strong>r than 0.6206, <strong>the</strong> result must be converted to g/dL using <strong>the</strong> appropriate conversion factor<br />

<strong>for</strong> that lab.<br />

8.5 – 10.0 g/dL 7.5 – 8.4 g/dL<br />

6.50 – 7.4 g/dL < 6.5 g/dL<br />

5.24 – 6.23 mmol/L 4.62–5.23 mmol/L 4.03–4.61 mmol/L < 4.03 mmol/L<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 57 days<br />

(HIV POSITIVE ONLY)<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 57 days<br />

(HIV NEGATIVE<br />

ONLY)<br />

10.0 – 10.9 g/dL<br />

6.18 – 6.79 mmol/L<br />

OR<br />

Any decrease<br />

2.5 – 3.4 g/dL<br />

1.58 – 2.13 mmol/L<br />

Comment: The decrease is a decrease from baseline<br />

Infant ∗† , 36 – 56 days<br />

(HIV POSITIVE OR<br />

NEGATIVE)<br />

Infant ∗† , 22 – 35 days<br />

(HIV POSITIVE OR<br />

NEGATIVE)<br />

Infant ∗† , ≤ 21 days<br />

(HIV POSITIVE OR<br />

NEGATIVE)<br />

8.5 – 9.4 g/dL<br />

5.24 – 5.86 mmol/L<br />

9.5 – 10.5 g/dL<br />

5.87 - 6.54 mmol/L<br />

12.0 – 13.0 g/dL<br />

7.42 – 8.09 mmol/L<br />

9.0 – 9.9 g/dL<br />

5.55 - 6.17 mmol/L<br />

OR<br />

Any decrease<br />

3.5 – 4.4 g/dL<br />

2.14 – 2.78 mmol/L<br />

7.0 – 8.4 g/dL<br />

4.31 – 5.23 mmol/L<br />

8.0 – 9.4 g/dL<br />

4.93 – 5.86 mmol/L<br />

10.0 – 11.9 g/dL<br />

6.18 – 7.41 mmol/L<br />

Correction: Parameter changed from “Infant < 21 days” to “Infant ≤ 21 days”<br />

International Normalized<br />

Ratio <strong>of</strong> prothrombin time<br />

(INR)<br />

7.0 – 8.9 g/dL<br />

4.34 - 5.54 mmol/L<br />

OR<br />

Any decrease<br />

≥ 4.5 g/dL<br />

> 2.79 mmol/L<br />

6.0 – 6.9 g/dL<br />

3.72 – 4.30 mmol/L<br />

7.0 – 7.9 g/dL<br />

4.34 – 4.92 mmol/L<br />

9.0 – 9.9 g/dL<br />

5.59- 6.17 mmol/L<br />

< 7.0 g/dL<br />

< 4.34 mmol/L<br />

< 6.00 g/dL<br />

< 3.72 mmol/L<br />

< 7.00 g/dL<br />

< 4.34 mmol/L<br />

< 9.0 g/dL<br />

< 5.59 mmol/L<br />

1.1 – 1.5 x ULN 1.6 – 2.0 x ULN 2.1 – 3.0 x ULN > 3.0 x ULN<br />

Me<strong>the</strong>moglobin 5.0 – 10.0% 10.1 – 15.0% 15.1 – 20.0% > 20.0%<br />

Prothrombin Time (PT) 1.1 – 1.25 x ULN 1.26 – 1.50 x ULN 1.51 – 3.00 x ULN > 3.00 x ULN<br />

Partial Thromboplastin<br />

Time (PTT)<br />

Platelets, decreased 100,000 –<br />

124,999/mm 3<br />

100.000 x 10 9 –<br />

124.999 x 10 9 /L<br />

WBC, decreased 2,000 – 2,500/mm 3<br />

1.1 – 1.66 x ULN 1.67 – 2.33 x ULN 2.34 – 3.00 x ULN > 3.00 x ULN<br />

2.000 x 10 9 –<br />

2.500 x 10 9 /L<br />

50,000 –<br />

99,999/mm 3<br />

50.000 x 10 9 –<br />

99.999 x 10 9 /L<br />

1,500 – 1,999/mm 3<br />

1.500 x 10 9 –<br />

1.999 x 10 9 /L<br />

25,000 –<br />

49,999/mm 3<br />

25.000 x 10 9 –<br />

49.999 x 10 9 /L<br />

1,000 – 1,499/mm 3<br />

1.000 x 10 9 –<br />

1.499 x 10 9 /L<br />

< 25,000/mm 3<br />

< 25.000 x 10 9 /L<br />

< 1,000/mm 3<br />

< 1.000 x 10 9 /L<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 17 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

CHEMISTRIES<br />

St<strong>and</strong>ard International Units are listed in italics<br />

Acidosis NA pH < normal, but ≥ 7.3 pH < 7.3 without lifethreatening<br />

consequences<br />

Albumin, serum, low<br />

3.0 g/dL – < LLN<br />

30 g/L – < LLN<br />

2.0 – 2.9 g/dL<br />

20 – 29 g/L<br />

< 2.0 g/dL<br />

< 20 g/L<br />

pH < 7.3 with lifethreatening<br />

consequences<br />

Alkaline Phosphatase 1.25 – 2.5 x ULN † 2.6 – 5.0 x ULN † 5.1 – 10.0 x ULN † > 10.0 x ULN †<br />

Alkalosis NA pH > normal, but ≤ 7.5 pH > 7.5 without lifethreatening<br />

consequences<br />

NA<br />

pH > 7.5 with lifethreatening<br />

consequences<br />

ALT (SGPT) 1.25 – 2.5 x ULN 2.6 – 5.0 x ULN 5.1 – 10.0 x ULN > 10.0 x ULN<br />

AST (SGOT) 1.25 – 2.5 x ULN 2.6 – 5.0 x ULN 5.1 – 10.0 x ULN > 10.0 x ULN<br />

Bicarbonate, serum, low<br />

16.0 mEq/L – < LLN<br />

16.0 mmol/L – < LLN<br />

11.0 – 15.9 mEq/L<br />

11.0 – 15.9 mmol/L<br />

8.0 – 10.9 mEq/L<br />

8.0 – 10.9 mmol/L<br />

< 8.0 mEq/L<br />

< 8.0 mmol/L<br />

Comment: Some laboratories will report this value as Bicarbonate (HCO 3 ) <strong>and</strong> o<strong>the</strong>rs as Total Carbon Dioxide (CO 2 ). These<br />

are <strong>the</strong> same tests; values should be graded according to <strong>the</strong> ranges <strong>for</strong> Bicarbonate as listed above.<br />

Bilirubin (Total)<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong> ><br />

14 days<br />

Infant ∗† , ≤ 14 days<br />

(non-hemolytic)<br />

Infant ∗† , ≤ 14 days<br />

(hemolytic)<br />

Calcium, serum, high<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 7 days<br />

Infant ∗† , < 7 days<br />

Calcium, serum, low<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 7 days<br />

Infant ∗† , < 7 days<br />

1.1 – 1.5 x ULN 1.6 – 2.5 x ULN 2.6 – 5.0 x ULN > 5.0 x ULN<br />

NA<br />

20.0 – 25.0 mg/dL<br />

342 – 428 µmol/L<br />

25.1 – 30.0 mg/dL<br />

429 – 513 µmol/L<br />

NA NA 20.0 – 25.0 mg/dL<br />

342 – 428 µmol/L<br />

10.6 – 11.5 mg/dL<br />

2.65 – 2.88 mmol/L<br />

11.5 – 12.4 mg/dL<br />

2.88 – 3.10 mmol/L<br />

7.8 – 8.4 mg/dL<br />

1.95 – 2.10 mmol/L<br />

6.5 – 7.5 mg/dL<br />

1.63 – 1.88 mmol/L<br />

11.6 – 12.5 mg/dL<br />

2.89 – 3.13 mmol/L<br />

12.5 – 12.9 mg/dL<br />

3.11 – 3.23 mmol/L<br />

7.0 – 7.7 mg/dL<br />

1.75 – 1.94 mmol/L<br />

6.0 – 6.4 mg/dL<br />

1.50 – 1.62 mmol/L<br />

Comment: Do not adjust Calcium, serum, low or Calcium, serum, high <strong>for</strong> albumin<br />

12.6 – 13.5 mg/dL<br />

3.14 – 3.38 mmol/L<br />

13.0 – 13.5 mg/dL<br />

3.245 – 3.38 mmol/L<br />

6.1 – 6.9 mg/dL<br />

1.53 – 1.74 mmol/L<br />

5.50 – 5.90 mg/dL<br />

1.38 – 1.51 mmol/L<br />

> 30.0 mg/dL<br />

> 513.0 µmol/L<br />

> 25.0 mg/dL<br />

> 428 µmol/L<br />

> 13.5 mg/dL<br />

> 3.38 mmol/L<br />

> 13.5 mg/dL<br />

> 3.38 mmol/L<br />

< 6.1 mg/dL<br />

< 1.53 mmol/L<br />

< 5.50 mg/dL<br />

< 1.38 mmol/L<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 18 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Cardiac troponin I (cTnI) NA NA NA Levels consistent with<br />

myocardial infarction<br />

or unstable angina as<br />

defined by <strong>the</strong><br />

manufacturer<br />

Cardiac troponin T (cTnT) NA NA NA ≥ 0.20 ng/mL<br />

OR<br />

Levels consistent with<br />

myocardial infarction<br />

or unstable angina as<br />

defined by <strong>the</strong><br />

manufacturer<br />

Cholesterol (fasting)<br />

<strong>Adult</strong> ≥ 18 years<br />

<strong>Pediatric</strong> < 18 years<br />

200 – 239 mg/dL<br />

5.18 – 6.19 mmol/L<br />

170 – 199 mg/dL<br />

4.40 – 5.15 mmol/L<br />

240 – 300 mg/dL<br />

6.20 – 7.77 mmol/L<br />

200 – 300 mg/dL<br />

5.16 – 7.77 mmol/L<br />

> 300 mg/dL<br />

> 7.77 mmol/L<br />

> 300 mg/dL<br />

> 7.77 mmol/L<br />

Creatine Kinase 3.0 – 5.9 x ULN † 6.0 – 9.9 x ULN † 10.0 – 19.9 x ULN † ≥ 20.0 x ULN †<br />

Creatinine 1.1 – 1.3 x ULN † 1.4 – 1.8 x ULN † 1.9 – 3.4 x ULN † ≥ 3.5 x ULN †<br />

NA<br />

NA<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Glucose, serum, high<br />

Nonfasting<br />

116 – 160 mg/dL<br />

6.44 – 8.88 mmol/L<br />

161 – 250 mg/dL<br />

8.89 – 13.88 mmol/L<br />

251 – 500 mg/dL<br />

13.89 – 27.75 mmol/L<br />

> 500 mg/dL<br />

> 27.75 mmol/L<br />

Fasting<br />

110 – 125 mg/dL<br />

6.11 – 6.94 mmol/L<br />

126 – 250 mg/dL<br />

6.95 – 13.88 mmol/L<br />

251 – 500 mg/dL<br />

13.89 – 27.75 mmol/L<br />

> 500 mg/dL<br />

> 27.75 mmol/L<br />

Glucose, serum, low<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 1 month<br />

55 – 64 mg/dL<br />

3.05 – 3.55 mmol/L<br />

40 – 54 mg/dL<br />

2.22 – 3.06 mmol/L<br />

30 – 39 mg/dL<br />

1.67 – 2.23 mmol/L<br />

< 30 mg/dL<br />

< 1.67 mmol/L<br />

Infant ∗† , < 1 month<br />

50 – 54 mg/dL<br />

2.78 – 3.00 mmol/L<br />

40 – 49 mg/dL<br />

2.22 – 2.77 mmol/L<br />

30 – 39 mg/dL<br />

1.67 – 2.21 mmol/L<br />

< 30 mg/dL<br />

< 1.67 mmol/L<br />

Lactate<br />

ULN - < 2.0 x ULN<br />

without acidosis<br />

≥ 2.0 x ULN without<br />

acidosis<br />

Increased lactate with<br />

pH < 7.3 without lifethreatening<br />

consequences<br />

Increased lactate with<br />

pH < 7.3 with lifethreatening<br />

consequences<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 19 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

Comment: Added ULN to Grade 1 parameter<br />

LDL cholesterol (fasting)<br />

<strong>Adult</strong> ≥ 18 years<br />

<strong>Pediatric</strong> > 2 - < 18<br />

years<br />

130 – 159 mg/dL<br />

3.37 – 4.12 mmol/L<br />

110 – 129 mg/dL<br />

2.85 – 3.34 mmol/L<br />

160 – 190 mg/dL<br />

4.13 – 4.90 mmol/L<br />

130 – 189 mg/dL<br />

3.35 – 4.90 mmol/L<br />

≥ 190 mg/dL<br />

≥ 4.91 mmol/L<br />

≥ 190 mg/dL<br />

≥ 4.91 mmol/L<br />

Lipase 1.1 – 1.5 x ULN 1.6 – 3.0 x ULN 3.1 – 5.0 x ULN > 5.0 x ULN<br />

Magnesium, serum, low<br />

1.2 – 1.4 mEq/L<br />

0.60 – 0.70 mmol/L<br />

0.9 – 1.1 mEq/L<br />

0.45 – 0.59 mmol/L<br />

0.6 – 0.8 mEq/L<br />

0.30 – 0.44 mmol/L<br />

NA<br />

NA<br />

< 0.60 mEq/L<br />

< 0.30 mmol/L<br />

Pancreatic amylase 1.1 – 1.5 x ULN 1.6 – 2.0 x ULN 2.1 – 5.0 x ULN > 5.0 x ULN<br />

Phosphate, serum, low<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

> 14 years<br />

<strong>Pediatric</strong> 1 year – 14<br />

years<br />

<strong>Pediatric</strong> < 1 year<br />

Potassium, serum, high<br />

Potassium, serum, low<br />

Sodium, serum, high<br />

Sodium, serum, low<br />

2.5 mg/dL – < LLN<br />

0.81 mmol/L – < LLN<br />

3.0 – 3.5 mg/dL<br />

0.97 – 1.13 mmol/L<br />

3.5 – 4.5 mg/dL<br />

1.13 – 1.45 mmol/L<br />

5.6 – 6.0 mEq/L<br />

5.6 – 6.0 mmol/L<br />

3.0 – 3.4 mEq/L<br />

3.0 – 3.4 mmol/L<br />

146 – 150 mEq/L<br />

146 – 150 mmol/L<br />

130 – 135 mEq/L<br />

130 – 135 mmol/L<br />

2.0 – 2.4 mg/dL<br />

0.65 – 0.80 mmol/L<br />

2.5 – 2.9 mg/dL<br />

0.81 – 0.96 mmol/L<br />

2.5 – 3.4 mg/dL<br />

0.81 – 1.12 mmol/L<br />

6.1 – 6.5 mEq/L<br />

6.1 – 6.5 mmol/L<br />

2.5 – 2.9 mEq/L<br />

2.5 – 2.9 mmol/L<br />

151 – 154 mEq/L<br />

151 – 154 mmol/L<br />

125 – 129 mEq/L<br />

125 – 129 mmol/L<br />

Triglycerides (fasting) NA 500 – 750 mg/dL<br />

5.65 – 8.48 mmol/L<br />

1.0 – 1.9 mg/dL<br />

0.32 – 0.64 mmol/L<br />

1.5 – 2.4 mg/dL<br />

0.48 – 0.80 mmol/L<br />

1.5 – 2.4 mg/dL<br />

0.48 – 0.80 mmol/L<br />

6.6 – 7.0 mEq/L<br />

6.6 – 7.0 mmol/L<br />

2.0 – 2.4 mEq/L<br />

2.0 – 2.4 mmol/L<br />

155 – 159 mEq/L<br />

155 – 159 mmol/L<br />

121 – 124 mEq/L<br />

121 – 124 mmol/L<br />

751 – 1,200 mg/dL<br />

8.49 – 13.56 mmol/L<br />

< 1.00 mg/dL<br />

< 0.32 mmol/L<br />

< 1.50 mg/dL<br />

< 0.48 mmol/L<br />

< 1.50 mg/dL<br />

< 0.48 mmol/L<br />

> 7.0 mEq/L<br />

> 7.0 mmol/L<br />

< 2.0 mEq/L<br />

< 2.0 mmol/L<br />

≥ 160 mEq/L<br />

≥ 160 mmol/L<br />

≤ 120 mEq/L<br />

≤ 120 mmol/L<br />

> 1,200 mg/dL<br />

> 13.56 mmol/L<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 20 <strong>of</strong> 21 Version 1.0/Clarification 1


DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF<br />

ADULT AND PEDIATRIC ADVERSE EVENTS<br />

VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009<br />

LABORATORY<br />

PARAMETER GRADE 1<br />

MILD<br />

GRADE 2<br />

MODERATE<br />

GRADE 3<br />

SEVERE<br />

GRADE 4<br />

POTENTIALLY<br />

LIFE-THREATENING<br />

Uric acid<br />

7.5 – 10.0 mg/dL<br />

0.45 – 0.59 mmol/L<br />

10.1 – 12.0 mg/dL<br />

0.60 – 0.71 mmol/L<br />

12.1 – 15.0 mg/dL<br />

0.72 – 0.89 mmol/L<br />

> 15.0 mg/dL<br />

> 0.89 mmol/L<br />

URINALYSIS<br />

St<strong>and</strong>ard International Units are listed in italics<br />

Hematuria (microscopic) 6 – 10 RBC/HPF > 10 RBC/HPF Gross, with or without<br />

clots OR with RBC<br />

casts<br />

Transfusion indicated<br />

Proteinuria, r<strong>and</strong>om<br />

collection<br />

1 + 2 – 3 + 4 + NA<br />

Proteinuria, 24 hour collection<br />

<strong>Adult</strong> <strong>and</strong> <strong>Pediatric</strong><br />

≥ 10 years<br />

200 – 999 mg/24 h<br />

0.200 – 0.999 g/d<br />

1,000 – 1,999 mg/24 h<br />

1.000 – 1.999 g/d<br />

2,000 – 3,500 mg/24 h<br />

2.000 – 3.500 g/d<br />

> 3,500 mg/24 h<br />

> 3.500 g/d<br />

<strong>Pediatric</strong> > 3 mo -<br />

< 10 years<br />

201 – 499 mg/m 2 /24 h<br />

0.201 – 0.499 g/d<br />

500 – 799 mg/m 2 /24 h<br />

0.500 – 0.799 g/d<br />

800 – 1,000<br />

mg/m 2 /24 h<br />

0.800 – 1.000 g/d<br />

> 1,000 mg/ m 2 /24 h<br />

> 1.000 g/d<br />

∗<br />

Values are <strong>for</strong> term infants. Preterm infants should be assessed using local normal ranges.<br />

†<br />

Use age <strong>and</strong> sex appropriate values (e.g., bilirubin).<br />

28 Dec-04/Clarification Aug 09 Page 21 <strong>of</strong> 21 Version 1.0/Clarification 1

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